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Better bone health: An apple a day to keep fractures away?

The Bottom Line

  • The risk of experiencing a fracture (a.k.a. breaking a bone) increases with age and the presence of diseases like osteoporosis. 
  • Hip fractures result in a reduced quality of life and increased risk of death.     
  • In adults aged 50 years old and over, eating more fruits and vegetables may lower the risk of experiencing hip fractures. 
  • Make a conscious effort to increase your consumption of fruits and vegetables. Refer to Canada’s food guide for tips on how to better incorporate these elements into your diet.   

Some things never change. Like that one piece of nutritional advice that’s been shared with us consistently throughout our lives. If you immediately thought of, “eat your fruits and vegetables,” then you’d be correct! Diet plays a major role in influencing our health and well-being (1-10). Fruits and vegetables are an essential part of a healthy diet. This notion is supported by Canada’s food guide, which lists consuming plenty of fruits and vegetables and favouring plant-based protein foods as “healthy food choices” (11).


While the benefits of diets rich in fruits and vegetables are regularly discussed in relation to weight management and chronic disease prevention (3;10;12), we don’t generally hear much about the benefits of consuming fruits and vegetables for our bones. When we consider the increased risk of fractures (a.k.a. broken bones) that is caused, in part, by reductions in bone density that occur as a natural part of aging and diseases such as osteoporosis that manifest as we age, it's important we implement strategies that reduce our risk for such injuries (13-15).


So, can a dietary strategy like eating more fruits and vegetables help us reduce our risk of fractures? One systematic review set out to provide answers (13).


What the research tells us

The review found that adults aged 50 years old and over who increase their intake of fruits and vegetables may be between 2% and 13% less likely to experience a hip fracture (13). Although this reduction in risk is small, it’s not unimportant when we take into account that hip fractures cause significant illness, decrease independence, mobility, and quality of life, and increase mortality in older adults (16-20). A small decline in the risk of fractures at any site (not just the hips)—specifically, a 4% to 14% reduction—was also seen, and while this is positive, this result is only based on a couple of studies. As such, it needs to be interpreted with caution. With all of that said, there’s still a need for more research in this area so we can further solidify these findings and increase our confidence in what they reveal. Future research needs to include larger numbers of participants who are more diverse (13).


You can’t go wrong with eating a healthy and well-balanced diet that’s rich in fruits and vegetables. The potential added benefits for your bones should only serve as one more reason to make a conscious effort to feature fruits and veggies on your plate.


Tips to increase fruit and vegetable intake


Canada’s food guide recommends the following strategies to help you eat more fruits and vegetables: 

  • Make it easier to incorporate fruits and veggies into your meals or snacks by preparing them for use in advance—i.e. cleaning, cutting, and placing them in the fridge or freezer for later use. 
  • Take advantage of pre-bagged veggies, such as leafy greens.  
  • Consider supplementing a meal with sides like raw veggies (e.g., carrots and cucumbers) and adding fresh fruit to your salads.  
  • Choose fruits for dessert. 

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References

  1. Firth J, Marx W, Dash S, et al. The effects of dietary improvement on symptoms of depression and anxiety: A meta-analysis of randomized controlled trials. Psychosom Med. 2019; 81(3):265-280.
  2. Schwingshackl L, Dias S, Hoffman G. Impact of long-term lifestyle programmes on weight loss and cardiovascular risk factors in overweight/obese participants: A systematic review and network meta-analysis. Syst Rev. 2014; 3:130.
  3. Hutfless S, Gudzune KA, Maruther N, et al. Strategies to prevent weight gain in adults: A systematic review. Am J Prev Med. 2013; 45(6):e41-e51.
  4. Shirani F, Salehi-Abargouei A, Azadbakht L. Effects of Dietary Approaches to Stop Hypertension (DASH) diet on some risk for developing type 2 diabetes: A systematic review and meta-analysis on controlled clinical trials. Nutrition. 2013; 29(7-8): 939-947. doi: 10.1016/j.nut.2012.12.021.
  5. Aguiar EJ, Morgan PJ, Collins CE, et al. Efficacy of interventions that include diet, aerobic and resistance training components for type 2 diabetes prevention: A systematic review with meta-analysis. Int J Behav Nutr Phys Act. 2014; 11(2). doi: 10.1186/1479-5868-11-2. 
  6. Hooper L, Martin N, Jimoh OF, et al. Reduced or modified dietary fat for preventing cardiovascular disease. Cochrane Database Syst Revs. 2020; 5:CD011737. doi: 10.1002/14651858.CD011737.pub2.
  7. Hernandez AV, Emonds EE, Chen BA, et al. Effect of low-sodium salt substitutes on blood pressure, detected hypertension, stroke and mortality. Heart. 2019; 105(12):953-960. doi: 10.1136/heartjnl-2018-314036.
  8. Zhang X, Imperatore G, Thomas W, et al. Effect of lifestyle interventions on glucose regulation among adults without impaired glucose tolerance or diabetes: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2017; 123:149-164. doi: 10.1016/j.diabres.2016.11.020.  
  9. Snorgaard O, Poulsen GM, Andersen HK, et al. Systematic review and meta-analysis of dietary carbohydrate restriction in patients with type 2 diabetes. BMJ Open Diabetes Res Care. 2017; 5(1):e000354. doi: 10.1136/bmjdrc-2016-000354. 
  10. Huo R, Du T, Xu Y, et al. Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: A meta-analysis. Eur J Clin Nutr. 2015; 69(11):1200-1208. doi: 10.1038/ejcn.2014.243. 
  11. Government of Canada. Canada’s food guide: Healthy food choices. Internet [2019]. Cited [Jan 2021]. Available from https://food-guide.canada.ca/en/healthy-food-choices/
  12. Huang R, Huang C, Hu F, et al. Vegetarian diets and weight reduction: A meta-analysis of randomized controlled trials. J Gen Intern Med. 2016; 31(1):109-116. doi: 10.1007/s11606-015-3390-7.
  13. Brondani JE, Comim FV, Flores LM, et al. Fruit and vegetable intake and bones: A systematic review and meta-analysis. PLOS ONE. 2019; 14:e0217223.  
  14. Black DM, Rosen CJ. Clinical practice. Postmenopausal osteoporosis. N Engl J Med. 2016; 374(3):254-262. 
  15. Rachner TD, Khosla S, Hofbauer LC. Osteoporosis: Now and the future. Lancet. 2011; 377(9773):1276-1287.
  16. Avenell A, Smith TO, Curtain JP, et al. Nutritional supplementation for hip fracture aftercare in older people. Cochrane Database Syst Revs. 2016; 11:CD001880. doi: 10.1002/14651858.CD001880.pub6.    
  17. Kanis JA, Odén A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporosis Int. 2012; 23(9):2239-2256. doi: 10.1007/s00198-012-1964-3.
  18. Cranney AB, Coyle D, Hopman WM. Prospective evaluation of preferences and quality of life in women with hip fractures. J Rheumatol. 2005; 32(12):2393-2399. 
  19. Bentler SE, Liu L, Obrizan M, et al. The aftermath of hip fracture: Discharge placement, functional status change, and mortality. Am J Epidemiol. 2009; 170(10):1290-1299. doi: 10.1093/aje/kwp266. 
  20. Mariconda M, Costa GG, Cerbasi S, et al. The determinants of mortality and morbidity during the year following fracture of the hip. Bone Joint J. 2015; 97(3):383-390. doi: 10.1302/0301-620X.97B3.34504. 

DISCLAIMER: Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of these blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations such as social distancing and frequent hand washing. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with current social distancing recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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